Case 29 - Chorioamnionitis

Cause?

Ascending infection from vaginal organisms.

Signs of chorioamnionitis?

Fouls smelling vaginal discharge, fever, maternal and fetal tachycardia, uterine tenderness. Associated with prolonged and premature rupture of membranes.

Confirmatory test for chorioamnionitis?

Gram stain of amniotic fluid revealing organisms

Management of intra-amniotic infection:

IV ABX and labor induction. Steroid use is contraindicated when there is active infection.

Most common complication associated with PROM?

Labor.

What organism is known for inducing chorioamnionitis without premature rupture of membranes?

Listeria monocytogenes.

Signs of fetal lung maturity when membranes rupture?

Rupture fluid positive for phosphatidyl glycerol.

Treatment of PPROM:

Steroids prior to 32 weeks. Broad spectrum ABX shown to delay delivery and decrease incidence of chorioamnionitis, Expectant management when risk of infection < risk of prematurity. After 34-35 weeks, treatment is usually delivery. Abruption is big risk associated with expectant management.

Latency period:

Time between rupture of membranes and induction of labor.

Fetal heart tracing with PPROM?

Variable decelerations due to cord compression from oligohydramnios due to fluid loss from rupture.

Preterm premature rupture of membranes:

rupture of membranes prior to induction of labor in a gestation prior to 37 weeks. Management is induction of labor if occurring after 34 weeks. Expectant management if occurring prior to 32 weeks.

Premature rupture of membranes:

rupture of membranes prior to induction of labor. Management is induction of labor.